Covid-19 Update - April 2021

Dear Patients,

We have some additional Covid-19/Vaccine information for you, but also some important office related updates further below.

1. Various Covid-19 vaccines are becoming much more available. This is one of the most important medical interventions ever. Taking the (very rare) contraindications into account, vaccine uptake should be somewhere between 99.9%-100% of the patients in our practices (ie – nearly every single one of you reading this).
2. The balance of risks and benefits for the vaccines is strongly in favour of vaccination. That being said, there are of course some risks (there’s risk in everything we do, including driving to work, swimming, etc). We will review issues regarding the risk of (very very rare) blood clots with some of the vaccines below.
3. If you have questions about the vaccines, please do not hesitate to book an appointment with us to discuss, we are happy to review it with you in detail.
4. If you are considering not being vaccinated, talk to us. We should really hear from you to:
   1.  Listen to your concerns
   2.  Answer any questions you have
   3. Discuss the overall pro’s and con’s
   4. There’s no ‘judgements’ here. Just facts, and our personal experiences for you to benefit from. This is about ensuring you have accurate information to make an informed decision. 
5. The most up to date information on getting a Covid-19 vaccine can be
   found here: https://www2.gov.bc.ca/gov/content/covid-19/vaccine/plan
6. The pandemic itself remains extremely serious. While much of the highest risk individuals in the population have received their first vaccine dose, we are seeing more, and younger, very sick patients. Maintaining protective measures is critical, likely until everyone gets BOTH doses of their vaccine (although the upcoming Johnson and Johnson one is a single dose shot).
7. The vaccines have now been shown to reduce not only severity of infection, but to actually prevent infection itself. They are not foolproof though, and there are some cases where vaccinated individuals have become sick. Thankfully they are usually far less sick than unvaccinated individuals, and deaths are extremely rare. Other counties that are further ahead than Canada in their vaccine rollout have seen cases absolutely plummet. Israel notably went from 4000 cases a day, to under 100 now. This despite relaxing protective measures in the course of that. Illnesses dropped in all age groups, suggesting decreased transmission to children when adults are vaccinated. The vast majority of their current cases and hospitalizations are unvaccinated individuals.
8. Our office (like most medical offices) continues to experience extreme challenges in managing the phone lines. We are called far more than prior to the pandemic, and our staff have a substantially increased workload compared to usual. This will likely settle down over the next few months, but please be patient with them…they are keen to help, but naturally appreciate kindness. Many of us are participating in vaccine clinics in our ‘spare’ time, so we are all quite busy.
9. Nearly all appointments are still primarily video/phone appointments, with the physician determining during that appointment if an in-office visit is necessary. We are hoping to open the system to in-office bookings again, but it will likely be at least another 2 months until then.
10.  Prescription refills – Please do NOT wait until the last minute to try to arrange refills. It’s stressful for you. It ends up being stressful for our staff and for us. It also makes it very difficult for us to keep urgent same-day appointments available for those who really need it – and there are a lot of those these days. Make sure you are tracking your medication supply, and arranging an appointment well ahead of time (if your prescription will run out in 3 months, book that appointment now, not 1 week before the 3 months is up). Think of it as if by doing this, you are helping someone else be able to get their urgent issue dealt with promptly. It makes a big difference.
11. If you have a real ‘prescription emergency’, please be aware that pharmacies are allowed to give you an emergency supply for as long as is needed until you can have an appointment with us (they typically give 2 weeks, but will readily give you a month upon request in most situations).
12. Please remember that some services are not covered by MSP, and we do bill privately for them. This is generally for services like work notes, forms, notes you need for your insurance company for physiotherapy/chiropractic or other treatments, and various other letters. In some cases, the visit to the physician itself is not covered and is billed privately. This generally occurs for driver’s exams, cosmetic related procedures/treatments, physical exams (‘checkups’) for those with no chronic medical condition/medical necessity for one, and any discussion regarding naturopath evaluations and treatments, or interpretations of ‘lab tests’ they ordered. Our fees are average based on guidelines from the “BC Doctors” association. Inquire with our staff any time for the most current fees prior to your visit / note request.
13. So what is the risk of a blood clot from the vaccines? First, to be clear, this risk is currently associated with the Astra Zeneca “Covishield” vaccine. It is a unique type of blood clot, called cerebral venous thrombosis (CVT), occurring in a specific part of the brain. There are important differences to ‘standard’ blood clots. The risk of a CVT blood clot is there, but it is very small. For context, the following are the risks of blood clots in various situations:
    1. Getting the Astra Zeneca vaccine: ~ 4 CVT blood clots per million people
    2. Taking the birth control pill: ~500-1200 ‘typical’ blood clots per million people
    3. Flying on a plane: ~1000 ‘typical’ blood clots per million people
    4. Smoking: ~ 1700 ‘typical’ blood clots per million people
    5. Getting Covid-19 itself: ~165000 (!) ‘typical’ blood clots per million people. For specifically CVT blood clots, it’s 40 per million (~ 10 times more than from the Astra Zeneca vaccine).

So remember, that while there is a risk of a blood clot from the vaccine, there is a far greater risk of all types of blood clots from Covid-19. Covid-19 is here, now. There is risk no matter which way you go. By taking the vaccine, you are reducing that risk dramatically from what it is right now. The blood clot risk applies to anyone taking the vaccine, and regardless of a history of prior blood clots. The average age has been ~46. Symptoms occur between days 4-20 after the vaccine is given. Symptoms include:

• headache
• seizure
• difficulty moving part of your body
• blurred vision
• shortness of breath
• chest pain
• abdominal pain (usually severe)
• swelling, pain, colour change in *any* limb

Early identification and treatment is key to a good outcome from this. If your symptoms are mild and you can reach us immediately, you can contact us to discuss. If your symptoms are severe, or if you cannot reach us immediately, someone should immediately take you to the emergency room (do not drive yourself), or call 911.

The pandemic has been trying on us all. We are so incredibly fortunate to live in a time where our scientific knowledge has advanced enough that we can change the course of a serious pandemic in 1 year. This isn’t over yet, and things may yet get worse before they get better, but we will hopefully all be taking our first clear steps back towards the world we were used to very soon now.

Keep well,
​
Your doctors at the North Shore Medical Group